After 25 years working the streets, paramedic John Tirpak says the time may be right to take the “emergency” out of “emergency medical services.”

Not permanently, of course. And not in every case.

The first job for community ambulance services always will be providing prompt medical attention and getting people safely to a hospital. But Tirpak sees an emerging role for EMS in the continuum of health care that is less about answering an emergency and more about preventing one; less about getting the “frequent flyer” patient to the hospital and more about making the hospital readmission unnecessary.

And Tirpak believes the result will be happier, healthier people and lower health-care costs overall due to more appropriate use of resources.

The question is whether Tirpak can convince others — read insurers — that the idea will work.

Tirpak is leading a fledgling effort at North Huntingdon EMS/Rescue to prevent falls among residents as part of a larger foray into preventive health services. A role for EMS outside emergency trips to the hospital is an idea that’s getting attention in the broader EMS community, but obstacles remain before paramedics become the newest home-care worker.

“The concept is having alternative interventions, such as disease management, to transition from acute emergencies to deal with people in a more holistic manner,” said Dan Swayze, vice president at the Center for Emergency Medicine of Western Pennsylvania, a University of Pittsburgh Medical Center affiliate. “There’s pretty good evidence we can prevent a lot of those readmissions.”

While North Huntingdon’s program gets its footing, a similar effort at the center has taken flight.

For about three years, the center’s staff of 2.5 equivalent paramedics have been visiting the homes of people just released from the hospital, making sure follow-up doctor’s appointments are made and prescriptions filled. The center receives per-visit fee reimbursement from UPMC Health Plan for providing the service. The fee was not disclosed.

Preliminary results of the center’s Safe Landing program show that patients who were visited by the paramedics had 16 fewer readmissions, 81 fewer days in the hospital and saved $1.2 million in hospital charges.

The program currently has more than 100 participants.

The results were equally impressive in a center pilot program involving 13 people with congestive heart disease, which has a hospital readmission rate of 24.8 percent nationally within 30 days. Paramedics made sure patients make follow-up doctor’s appointments and helped resolve medication issues.

Among the patients paramedics visited, only one had a readmission within 90 days. Savings were projected at $800 per $1 invested in the program.

And finally, paramedics several years ago visited the homes of people with asthma to provide disease education and related aid. Here were the results: the 42 people visited had fewer emergency room visits and shorter hospital stays than a control group, returning $4.68 for every $1 invested in the program.

Getting squeezed

There is another reason EMS agencies are looking at new service lines.

EMS agencies, like all health care providers, are facing a squeeze on reimbursement from insurers.

Transports at North Huntingdon comprise 83 percent of the service’s revenue, and starting up an ambulance for a non-emergency call costs the nonprofit agency about $300.

But the Medicare reimbursement for the trip is only $205.44 plus mileage, according to Executive Director Christopher T.E. Price.

“We’re always going to err on the side of what’s right for the patient,” Price said. “We end up transporting people who we know we’re not even going to be able to send them a bill.”

A neighbor in his 80s who fell and later died in a nursing home from complications of the fall sparked Tirpak’s curiosity in the injury, he said.

“No one should end their life that way,” he said.

“It’s always been something in the back of my head — I wish we could do something to prevent something like this from happening.”

So, North Huntingdon began looking at trip sheets from 2009, 2010 and part of 2011. The ambulance and rescue service clocks about 4,000 calls annually, and what Tirpak found was that falls comprised about 20 percent of the total.

Most of the falls occurred in the home and other studies have shown that men are more likely than women to die from fall-related injuries, Tirpak said. Head and extremity injuries were more common among people who fell than hip fractures, which surprised Tirpak.

In ramping up for the start of the home assessment program, North Huntingdon connected with a contractor, electrician and home-care agency to use for referrals for such things as installation of shower grab bars, when needed. Paramedics also check the resident’s medications.

Finding a role

Health-care reform seeks to better coordinate care between hospital, rehabilitation center and home and to manage large groups of patients with chronic medical problems.

Problems such as diabetes and heart disease account for roughly 80 cents of every dollar spent on health care, and Tirpak sees a role for EMS in reducing those costs.

The hitch is ambulance services only get paid when someone is taken to the hospital, said Dr. Daniel Swartz, who provides medical direction to North Huntingdon paramedics from Forbes Regional Hospital in Monroeville.

“What they need now is the resources to address the problem,” he said. “And that’s where they’re stuck.”

No insurer pays to make sure a home is free of trip hazards or that people just home from the hospital make the necessary follow-up doctor appointments and understand their medications before a trip to the emergency room is necessary. But health-care reform, with its focus on prevention, elimination of unnecessary hospital readmissions and population health, may change all that.

‘Right on target’

North Huntingdon’s fall prevention effort is “right on target,” according to Joe Schmider, director of Pennsylvania’s EMS bureau, which is part of the department of health.

An EMS agency’s biggest expense is personnel, which has to always be available whether or not there are calls, Schmider said.

Using staff to do home assessments or follow-up calls, for example, is a more efficient use of resources.

“It make a whole lot of sense,” Schmider said. “It gets more resources out into the community.”

“This is getting momentum, especially with the changes from Washington. It’s a great role for EMS.”